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To the Editor: In their Commentary on building physician work hour regulations using first principles and best evidence, Drs Volpp and Landrigan¹ offer 3 possibilities to explain the inconsistent benefits observed in studies to assess the effect of reduced house staff work hours: the work rules either are not restrictive enough, are inconsistently applied, or are thwarted by poor transition practices. The authors dismiss what must be the first consideration in scientific inquiry—that the hypothesis on which the original changes were based was incorrect.

Adequate sleep is important for optimal performance, especially during formalized testing. However, the important question is whether, in the complex environment of a teaching hospital, the changes required to increase sleep opportunity will be beneficial, neutral, or detrimental to patient outcomes. What if patients benefit from receiving care from a highly familiar and consistent caregiver during the first 24 hours of their illness? What if increased . . . [Full Text of this Article]

Louis B. Rice, MD
louis.rice@va.gov
Medical Service
Louis Stokes Cleveland VA Medical Center
Cleveland, Ohio

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